Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - April 19, 2023

Attendees

POEAG Members: Rhonda Buhrmester, Kristine Cram, Carla Cespedes, Dawn Cetti, Valerie Eriole, Pamela Fritz, Sharee Hummer, Catherine Hamilton, Kimberly Hanson, Paul Kesselman, Tugba Koca, Maria Koehnlein, Jeannette Leon, Gary Marano, Bill Noyes, Yvette Nugent, Tina Padden, Jan Palmer, Charles Robinson, Megan Raszkowski, Erica Rochelle, Randy Stevens, Rhonda Turner, Melinda Eberhart

Noridian Attendees: Ruth Reese, Kloe Roberts, Cindy White, Amber Mertz, Ashley Decoteau, Brenda Swancy, Colleen Harryman, Dan Schmitt, Kelsey Slettebak, Mary Reineke-Ferguson, Melissa Betts, Shelly Carlson, Stacy Dahl, Tanya Gillies

POE Advisory Group Mission and Goals

Mission

  • To determine the best methods of providing quality education and training to our supplier community.

Goals

  • Develop timely, useful, relevant educational opportunities for our suppliers
  • Provide input in the creation, implementation and review of Provider Education and Training
  • Determine innovative, cost effective methods of using technology in provider education and training CMS Internet Only Manual (IOM), Publication 100-09, Chapter 6

Standing Agenda Items

Follow-up from Previous Meeting

General

  • Joint POEAG to develop education for clinicians ordering DMEPOS
    • Five meetings have been held focusing on sleep
      • Great suggestions being worked on
        • Provide education during residency
        • More webinars for providers on DME requirements
        • Update clinician checklist
    • Newsletter
    • Looking for supplier volunteers for a similar Glucose meeting, willing to recruit practitioners
      • Tabled
      • Starting a glucose project with Medical Policy
  • Collaborative MAC education
    • Knee Orthoses
      • February 2023
    • Oxygen
      • April 2023
    • Lower Limb Orthoses
      • June 1, 2023
    • Surgical Dressings
      • Quarter three
    • Therapeutic Shoes for Persons with Diabetes
      • Quarter four
  • Hospice and DME education
    • Webinar will be held April 26, 2023
  • Level 200 webinars
    • Please send scenarios you would like to see included

DME

  • Removal of Certificate of Medical Necessity (CMN) and DME Information Form (DIF)
    • January 2023
  • FreeStyle Libre 3 not covered, education for practitioners
    • Added to
      • Webinar
      • Clinician checklist
      • Website
  • Therapeutic Shoes for Persons with Diabetes "incident to" guidance
    • Clarification was added to webinar
  • Education on appealing Comprehensive Error Rate Testing (CERT) denials
  • National Supplier Clearinghouse is now National Provider Enrollment (NPE)
    • Effective November 7, 2022
    • East of Mississippi is NPE East
      • Novitas Solutions
    • West of Mississippi is NPE West
      • Palmetto GBA
  • New Medicare Part B immunosuppressant drug benefit

O&P

  • Ten orthoses codes added to Required Face-to-Face and Written Order Prior to Delivery list

New Items

General

  • Ask the contractor teleconference (ACT)
    • Scheduled for 2023
      • May 11, 2023, 2 p.m. CT
    • General - all topics

DME

  • New Oxygen Modifiers Required April 1, 2023
    • Required for initial claims with dates of service on or after April 1, 2023
      • N1- Group I oxygen coverage criteria met
      • N2- Group II oxygen coverage criteria met
      • N3- Group III oxygen coverage criteria met
  • KX or N1, Oxygen Modifiers N2, N3
    • Effective for new oxygen rental periods beginning on or after April 1, 2023
      • N1, N2, or N3 modifiers will be billed in place of the KX modifier
    • Initial claims for oxygen rental periods with dates of service on or after April 1, 2023
      • Rejected if billed with a KX modifier
    •  Oxygen rentals that began prior to April 1, 2023
      • May continue to be billed with KX modifier for remainder of rental period and for subsequent billing of oxygen contents or maintenance and service
  • Joint Oxygen FAQ
  • Voluntary Prior Authorization of Certain Power Mobility Device (PMD) Accessories
  • Revised Glucose Monitor Local Coverage Determination
    • Final LCD effective for dates of service on or after April 16, 2023
    • Removed three or more daily administration of insulin or continuous subcutaneous insulin infusion from CGM coverage criterion
    • Removed treatment regimen requiring frequent adjustment from CGM coverage criteria
    • Added initial coverage CGM criterion related to history of problematic hypoglycemia
    • Revised to include telehealth visits
    • Updated base with respective supply allowance monthly billing codes
      • Removed K0554 and K0553
      • Added E2103 and A4239
  • Insulin Coinsurance Limitation when furnished through DME
    • Effective July 1, 2023
    • Waives Part B deductible for insulin furnished through DME
    • Limits beneficiary coinsurance for insulin to $35 per month
    • Supplier payment adjusted as necessary to meet remaining amount for month’s supply
      • Supplier not responsible for balance of reduced coinsurance
    • For "from date of service" in May and June:
      • Do not bill a 3-month supply of insulin
      • Bill 1-month supply of insulin with JK modifier
    • For "from date of service" in July and later
      • JK modifier required for 1-month supply
      • JL modifier required for 3-month supply
    • CMS MLN Fact Sheet

O&P

  • No major updates

Suggestions from POE Advisory Members

  • Thank you for attending the National Home Infusion Association (NHIA) annual event, feedback was positive from attending suppliers. Special thank you to Amber Mertz.
  • Will Noridian provide additional education on the use of the JZ modifier for single dose vial drugs.
    • The use of the JZ modifier does not go into effect until July 1, 2023, and is only appended when a single dose vial is administered with no wastage.
    • Education on the use of the JZ modifier has been added to the webinars affected and to the Noridian website.
  • Curious to know how the use of the KX modifier is going for external infusion pump suppliers. When and if the Enteral and Parenteral Nutrition LCD will be updated to reflect those modifiers?
    • Currently, we do not have any updates on LCD revisions for enteral and parenteral policies. The KX modifier is working well from a claims side.
      • The 99 modifiers should be used for overflow when there are more than four modifiers needed on a claim line.
  • Suppliers are finding that the post PHE documentation is overwhelming. Would appreciate it if the DME MACs would highlight specific documents or sections of documents that pertain specifically to DME.
  • Will Noridian update the CGM clinician checklists with new policy information?
    • This was updated on March 29, 2023. Suppliers may need to clear the cache within their web browser for updates to show.
      • DMDs are working on the Dear Clinician Letters for CGM as well.
  • Can the CGM G7 monitor be added to the chart on the existing CGM Noridian webpage?
    • Noridian will work on adding this new device to the website.
  • Questions on prior authorization for Lower Limb Prosthetics (LLPs) have increased, will education a level 200 webinar on this topic? If not potentially add more basic level webinars on to the schedule that cover this topic.
    • Education will look into creating a level 200.
      • Suppliers can call the pre-claim hotline to see why they are not receiving approved prior authorizations and what is needed for their Additional Documentation Request (ADR).
  • We are having problems getting paid for a second leg bag when bundling one with the catheter for urological patients. Is Noridian seeing this with other suppliers?
    • We have not heard of this issue from other suppliers. Please reach out to the call center. If the call center has already been contacted, we will reach out to you after this call to discuss your specific situation.
  • We are having difficulty with three DME suppliers that have submitted enrollment to Novitas. When we call Novitas we are told that they are waiting on CMS approval of the fingerprints. What can be done to get this expedited?
    • Noridian cannot assist with the provider enrollment process. These suppliers will need to continue to work with Novitas.
  • Will Noridian add drug HCPCS codes to a look-up tool?
    • We can look into the addition of drug HCPCS codes.

Upcoming Meeting

  • Next Meeting: July 19, 2023, 12 p.m. CT/1 p.m. ET - First JA/JD combined meeting

 

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